Interventions improve cancer screening rates among women in rural areas
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GENEVA — Remote interventions led to higher screening rates for breast, cervical and colorectal cancers among women who live in rural areas, according to study results presented at World Cancer Congress.
More efforts are needed to improve screening rates among women who live in disadvantaged areas in rural regions, researchers concluded.
Rationale and methods
Prior research showed lower cancer screening rates and higher cancer mortality rates in rural areas than urban areas.
Electra Diane Paskett, PhD, professor and director of the division of cancer prevention and control in the department of internal medicine at The Ohio State University College of Medicine, and colleagues conducted a randomized controlled trial that included 983 women aged 50 to 74 years (mean age, 58.6 years; 97% white; 86% high school education or higher) who lived in 99 rural counties in Ohio and Indiana and were not up to date on breast, cervical or colorectal cancer screening.
Researchers assessed the effectiveness of three strategies — a mailed tailored DVD intervention, a DVD intervention plus patient navigation by telephone, or usual care — on screening rates.
The interventions focused on concepts such as knowledge, perceived personal risk for cancer, and overcoming barriers to obtaining necessary tests.
“We had been working in rural counties for a long time and noticed that the cancer screening rates were low. But we didn’t want to focus on one cancer screening test, so we focused on three tests,” Paskett told Healio. “I also had the idea to not only look at individual-level socioeconomic status but also area-level as another factor that affects quality health care.”
Investigators used the Area Deprivation Index — which allows for rankings of neighborhoods by socioeconomic disadvantage at the census block level — to examine the effect of area deprivation on screening and intervention effectiveness. Specifically, researchers compared women who lived in regions with Area Deprivation Index scores of less than 80 vs. those with scores of 80 to 100.
Key findings
At baseline, 19% of women required all three cancer screening tests, 29% required two and 52% required one.
At 12 months, 10% of women in the usual care group received all needed screenings compared with 15% of women assigned the mailed DVD intervention (OR = 1.9; P < .001) and 30% of those assigned the combined DVD and telephonic patient navigation intervention (OR = 5.8; P < .001).
One-quarter (25%) of women in the usual care group received any type of screening at 12 months, compared with 29% of those assigned the DVD intervention and 49% of those assigned the combined DVD and telephonic patient navigation intervention (OR for DVD/telephonic navigation vs. usual care = 3.8; P < .001).
Researchers calculated the average national percentile of adjusted Area Deprivation Index of 66 (range, 1-100) for the sample, with higher scores equating to higher levels of economic deprivation.
Results revealed a significant association between Area Deprivation Index scores and receipt of any screening (P = .031) or all needed screenings (P = .004) at 12 months.
Women who lived in areas with higher Area Deprivation Index scores appeared less likely than those who lived in areas with lower scores to be up to date with all needed cancer screenings (14% vs. 22%; OR = 0.58; 95% CI, 0.35-0.92) or any cancer screening (29% vs. 38%; OR = 0.68; 95% CI, 0.46-0.99).
Looking ahead
High deprivation areas have lower education levels, as well as higher levels of poverty and unemployment, which create barriers to cancer screening. Residents of rural high-deprivation regions face additional barriers, including less access to quality care and increased travel time.
Future efforts are needed to target disadvantaged areas in rural regions to increase screening rates, Paskett said.
“We would now like to test our intervention in the implementation science framework so that we can go to health care providers or clinics in areas that have higher Area Deprivation Index scores and offer these remote cancer screening interventions,” Paskett said.
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Paskett ED, et al. Abstract 1959. Presented at: World Cancer Congress; Oct. 18-20, 2022; Geneva.
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